This document summarizes a study that evaluated the effectiveness of perineal care on episiotomy pain and wound healing among postpartum women. The study used a quasi-experimental design and assessed 60 postpartum women, assigning them to either an experimental group that received perineal care or a control group. Results showed that women who received perineal care had lower episiotomy pain scores over 3 days and better wound healing progress measured using the REEDA scale, compared to the control group. The study concluded that perineal care is effective in reducing episiotomy pain and improving wound healing among postpartum women.

1. Journal of Pharmaceutical Negative Results ¦ Volume 13 ¦ Special Issue 6 ¦ 2022 509
“Evaluate the Effectiveness of Perineal Care on
Episiotomy Pain and Wound Healing among Postpartum
Women”
Namrata Limbachiya1
, Neha Parmar2*
1
Second Year M.Sc Nursing, Dinsha Patel College of Nursing, Nadiad.
2*
Assistant Professor, HOD of Obstetrical and Gynecological Nursing Department, Dinsha Patel College of Nursing, Nadiad.
Email: nimulimbachiya891997@gmail.com
DOI: 10.47750/pnr.2022.13.S06.070
Introduction: Over 85% of women having a vaginal birth suffers perineal trauma. The rate of episiotomy was determined as 93.3% in
primipara women and as 30.2% in multipara women. One of the most important aspects of perineal care is checking for signs of infection.
Most women have some degree of discomfort during the first few postpartum days. One of the common causes of discomfort is episiotomy.
These include swelling, lesions, rashes, sores and boils. Proper care of perineum after childbirth is very important in order to avoid infection
and speed healing of rectal and pelvic muscles. The Objectives are 1. To assess the episiotomy wound healing and pain among post partum
women in experimental and control group . 2. To evaluate the effectiveness of perineal care among post partum women 3. To compare the
Episiotomy pain and wound healing among post partum women between experimental and control group.4. To determine the association
between Episiotomy pain level and wound healing among postpartum women with their demographic variable.
Material & Methods: The Quasi Experimental post-test only control group design was adopted. With 60 postpartum women’s were selected
by non-probability convenient sampling technique. The prior consent was taken. Tool for data collection for Assessment of Episiotomy
wound healing by REEDA scale and Numerical pain rating Scale for Episiotomy Pain.
Results: The Results of the study revealed that statistically significant reduction in the level of perineal pain at 6, 24, & 48 hours and three
days postpartum between the two groups
A highly statistical significant difference between groups in relation to the interference of pain with walking, sitting, and urination at 24 &
48 hours, and at three days postpartum. Reduction in the REEDA scores of wound healing in experimental group as compared to control
group. The current study concluded that, women who received perineal care on episiotomy pain and wound healing during postpartum period
have, lower the level of postpartum episiotomy pain scores, decrease pain related to perineal episiotomy which interfere with women’s daily
activities postpartum, such as walking, sitting, urination and defecation, and better wound healing progress. On the light of the study findings
it is recommended that self perineal pain instruction can be introduced to the women antenatal and then it can be used postnatal, the nursing
students should be taught the importance of relieving episiotomy pain and enhancing wound healing in postnatal mothers, and there is a need
for extensive and intensive research in this area.
Keywords: Evaluate, Effectiveness, Perineal care, Episiotomy wound, Post Partum women.
INTRODUCTION
Motherhood is a beautiful process whereby the mother safely delivers a child. It is the magic of creation. Care must be given to
ensure safe childbirth. Safe motherhood initiative announced long back in 1987 had set targets to reduce maternal mortality rate
by 50% in one decade. Labour is defined as a “series of events that take place in the genital organs in an effort to expel the
viable products of conception out of the womb through the vagina into the outer world”. Labour passes mainly through four
stages of which first stage lasts for 12 hours in primigravidae and 6 hours in multi Para. The second stage lasts for 2 hours in
primigravidae and 30 minutes in multipara. The third stage lasts for 15 minutes in both primigravidae and in multipara. The
fourth stage is called as an observational phase lasting for at least 1hour in both mother and baby in multipara and
primigravida[1].

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Midwives have cared for women during childbirth for thousands of years. The meaning of the word midwife is "with woman,"
and the midwife's role is to offer supportive care to the expectant mother. In general, midwives use fewer interventions than
obstetricians and place greater trust in birth as a normal process[2]. During labour, midwives can literally play a vital role they
will be there throughout the birth to 2 reassure the parents, administer pain relief, encourage the mother with her breathing, talk
her through the different stages of labour and eventually deliver the baby[3].
An episiotomy also known as perineotomy, is surgically planned incision on the perineum and the posterior vaginal wall during
second stage of labor. The incision, which can be midline or at an angle from the posterior end of the vulva, is performed under
local anesthetic , and is sutured closed after delivery. Episiotomy is done as prophylaxis against soft-tissue-trauma. Vaginal
tears can occur during childbirth, most often at the vaginal opening as the baby's head passes through, especially if the baby
descends quickly. The midwife or obstetrician may decide to make a surgical cut to the perineum with scissors or scalpel to
make the baby's birth easier and prevent severe tears that can be difficult to repair. The cut is repaired with stitches. Some
childbirth facilities have a policy of routine episiotomy [4]. There are mainly four types of episiotomy. Medio-lateral: The
incision is made downward and outward from midpoint of fourchette either to right or left. It is directed diagonally in straight
line which runs about 2.5 cm away from the anus. Median: The incision commences from centre of the fourchette and extends
on posterior side along midline for 2.5 cm. Lateral: The incision starts from about 1 cm away from the centre of fourchette and
extends laterally. 'J' shaped: The incision begins in the centre of the fourchette and is directed posteriorly along midline for
about 1.5 cm and then directed downwards and outwards along 5 or 7 o'clock position to avoid the anal sphincter. This is also
not done widely 4 . The first episiotomy was reported in 1741, being suggested as a way to prevent severe perineal tears. The
worldwide rate of episiotomy increased dramatically in the early 1900's, coinciding with the move from women giving birth at
home to having their baby in a hospital. This is when physicians became more involved in the normal, uncomplicated birth
process[5].
with the healing process. These are: redness, edema, ecchymosis, discharge and approximation of skin edges. Each category is
assessed and a number assigned for a total REEDA score ranging from 0–15. The higher scores indicate increased tissue trauma.
This tool appears to be the first systematic attempt to evaluate postpartum healing, which acknowledges the need for a
standardized assessment tool independent of the severity of the perineal injury[6].
OBJECTIVES:
1. To assess the episiotomy wound healing among post partum women in experimental and control group
2. To assess the pain level on episiotomy wound among post partum women in experimental and control group.
3. To evaluate the effectiveness of perineal care among post partum women in experimental and control group.
4. To compare the Episiotomy pain and wound healing among post partum women between experimental and control group.
5. To determine the association between Episiotomy pain level and wound healing among postpartum women with their
demographic variable.
HYPOTHESES:
H1: There will be significant difference between the perineal care on Episiotomy pain in experimental group at 0.05 level of
significant after administration of Numerical pain scale.
H2 : There will be significant difference between the perineal care on Episiotomy wound healing in experimental group at 0.05
level of significant after assessment of REEDA scale.
H3 : There will be significant association between the perineal care on Episiotomy pain with selected demographic variables
in experimental group at 0.05 level of significant.

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511
H4 : There will be significant association between the perineal care on Episiotomy wound healing with selected demographic
variables in experimental group at 0.05 level of significant.
Material and Method:
Research Approach: Quantitative research approach.
Research Design: Quasi experimental –Post test only control group design
Research Variables:
1. Independent Variable: Perineal care
2. Dependent Variable: Episiotomy wound
Population: Postpartum women
Research Setting: The present study was conducted at Civil hospital , Nadiad.
Sampling Technique: Non-probability convenient sampling technique.
Sample Size: 60 postpartum women. (30-experimental and 30-control groups)
Sample Criteria:
1) Inclusion Criteria:
Postpartum Women:
• Patients who will give consent to participate in the study.
• postnatal mothers who are present at the time of data collection.
• Post natal mother who having episiotomy.
• Gestational age between 37-42 weeks.
• New born weight between 2500 to 4000 grams.
• No history of disease impaired wound healing
• Those who can understand Gujarati and Hindi language.
2) Exclusion criteria:
• Who will not available at the time of data collection.
• Who will not willing to participate.
• Who are taking other forms of treatment like antibiotic cream, Bitadin and savlon.

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• Diagnosed with Diabetes, Cogulation disorders, Puerperal sepsis etc.
• Perineal tear grades 3 and 4
• Newborn hospitalization.
• Having valvo vaginitis and hematoma or abscess in perineum,
Tools for Data Collection: The tool for data collection consists of the following section:
• Section A: Demographic variable consist of items on age, religion, education and income and obstetrical datetc..
• Section B: Assessment of Episiotomy wound healing by REEDA scale.
• Section C:Numerical pain rating Scale for Episiotomy Pain Aassessment.
STATISTICAL ANALYSIS:
The data were analyzed by using the SPSS Software. The frequency and percentage distribution are used to assess the
demographic variables and the mean and standard deviation are used to describe the experimental and control group for level
of episiotomy wound healing and pain among postpartum women.The paired t-test was used to comparison episiotomy wound
healing and Numerical pain scale on day1, day2, day3 and overall , Karl Pearson correlation formula was used to correlate the
post test level of episiotomy wound healing and pain and Chi-square test was used to determine the association between mean
differences. ANOVA F-test was carried out to find out significant effectiveness and the outcome of the ANOVA test evidence
that there is significant effectiveness of perineal care on episiotomy level of pain at the level.
RESULT: The results of this study are presented under five healings,
Demographic and obstetrical characteristics of women.Out of 60 samples, 43.3 % (13) in experimental group & 66.7%(20)
control group belong to age 22-25 years, 50% (15) belong to Hindu religion in experimental group and, 73.3% (22) belongs to
Hindu religion from control group. 56.7(17) in experimental and 83.3%(25)was primary-secondary educated, 46.7% (14) was
doing Labour work in Experimental group and 63.3%(19 )was housewife in control group, 36.7% (11) in experimental group
and in 66.7%(20) control group belong to 5000rs -10001 monthly income, 46.7% (14) Experimental group and 56.7%(17) in
control group have Joint family, 66.7% (20) in experimental group and 80%(20) in control group have area of residency in
rural,70%(21) in both group belong to no any bad habits
In Obstetrical data result was clearly state that 66.66% primigravida, 33.33% multigravida in experimental group ,In type of
Episiotomy there was 100% mediolateral Episiotomy in both group. Mostly postpartum mothers belongs to Gestational age
36.70% in 39 week,having 36.70% Experimental group in control group 43.30% in 38 weeks of gestational. In reason of
episiotomy outcome was 30% for prevent birth injury in experimental group in control group refers to 53.30% prevent birth
injury. Broadly postpartum women refers to 66.66% primigravida in experimental group & 73.33% primigravida in control
group. In both group having normal delivery about 83.33% and 86.66%.Postpartum women mostly refers to 12 hourly duration
of delivery in experimental and control group.

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Table 1. Frequency and percentage distribution of postpartum women according post-test level of wound healing regarding
perineal care.
Days
Wound Healing
REEDA Scale
Experimental Group Control Group
No. % No. %
Day -1
Good Healing
(0-5)
0 0% 0 0%
Average Healing
(6-10)
2 7% 6 20%
Poor Healing
(11-15)
28 93% 24 80%
Day -2
Good Healing
(0-5)
0 0% 0 0%
Average Healing
(6-10)
29 97% 12 40%
Poor Healing
(11-15)
1 3% 18 60%
Day -3
Good Healing
(0-5)
17 57% 0 0%
Average Healing
(6-10)
13 43% 18 60%
Poor Healing
(11-15)
0 0% 12 40%
Overall
Mean
Good Healing
(0-5)
0 0% 0 0%
Average Healing
(6-10)
30 100% 18 60%
Poor Healing
(11-15)
0 0% 12 40%
The above table 1 describes the percentage distribution of REEDA score on episiotomy wound healing of postpartum women’s.
The postpartum women’s had good healing about 57% and 43% had average healing in Experimental group on 3rd day of
perineal care. Where as in control group 40% of them had poor healing, and 60% of them had average healing due to no
exposure to perineal care. Its evidence that there is significant difference in control and experimental group after perineal care.
Hence, the stated hypothesis one was accepted due to significant differences between two groups.
Table 2. Frequency and percentage distribution of postpartum women according post-test level of pain regarding perineal care
Days Level of Pain
Experimental Group Control Group
No. % No. %
Day -1
Mild Pain
(1-3)
0 0% 0 0%
Moderate Pain
(4-6)
6 20% 23 77%
Severe Pain
(7-10)
24 80% 7 23%

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Day -2
Mild Pain
(1-3)
0 0% 0 0%
Moderate Pain
(4-6)
29 97% 11 37%
Severe Pain
(7-10)
1 3% 19 63%
Day -3
Mild Pain
(1-3)
16 53% 0 0%
Moderate Pain
(4-6)
14 47% 21 70%
Severe Pain
(7-10)
0 0% 9 30%
Overall
Mean
Mild Pain
(1-3)
0 0% 0 0%
Moderate Pain
(4-6)
29 97% 8 27%
Severe Pain
(7-10)
1 3% 22 73%
The above table 2 describes the percentage distribution of numerical pain scale score on episiotomy level of pain among
postpartum women’s. The postpartum women’s on the day-3 had mild pain about 16 (53%)and (14) 47% had moderate pain in
Experimental group on after perineal care. Where as in control group (21)70% of them had moderate pain, and 9 (30%) of them
had Severe pain due to no exposure to perineal care. Its evidence that there is significant difference in control and experimental
group after perineal care. Hence, the stated hypothesis one was accepted due to significant differences between two groups.
Table 3. Effectiveness of perineal care on episiotomy level of pain (Numerical pain Scale) of postpartum women’s in
experimental group. (N=30)
Days
Level of Pain
Repeated
measures
ANOVA F-test
Experimental Group
Range Mean Mean % SD
Day-1 3 7.10 71% 0.758
F=206.81
df=2
P=0.00 ***
Day-2 3 5.16 52% 0.791
Day-3 4 3.46 35% 1.041
The above table no. 3 shows the effectiveness of the perineal care on episiotomy level of pain among postpartum women’s.
Repeated measures ANOVA F-test was carried out to find out significant effectiveness and the outcome of the ANOVA test
evidence that there is significant effectiveness of perineal care on episiotomy level of pain at the level of P<0.05.The obtained
“f”

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515
Table 4. Comparison of Day1, Day2, Day 3 and overall mean post test scores of Numerical pain scale (level of pain)among
postpartum women’s
Numerical pain scale (level of pain)
Day
Experimental Control Student’s
Independent
t-test
Mean SD Mean SD
Day 1 7.10 0.758 6.93 0.639
T value 0.920
Df 58
P value- 0.362
Day 2 8.56 1.104 6.73 0.639
T value 7.868**
df 58
P value 0.000
Day 3 3.466 1.041 6.266 0.739
T value 12.04**
df 58
P value 0.000
Overall
Mean score
5.24 0.700 4.260 0.390
T value 6.717**
df 58
P value 0.000
The above table no 4 shows that Comparison Numerical pain scale on day1, day2, day3 and overall mean score of postpartum
women’s. There was a significant difference between post numerical pain scale score in terms of level of pain among postpartum
women’s in Experimental and control group. The obtained “t” was significant at 0.05 levels. So, hence the stated hypothesis
for comparison was accepted.was significant at 0.05 levels. So, hence the stated hypothesis for effectiveness was accepted.
Table 5 Association between demographic variables of postpartum women’s and level of wound healing and level of pain
scale score in experimental group. (n=30)
Demographic
Variable
Level of Wound
Healing
χ2
Value
Table
Value
P-Value
Level of Pain χ2
Value
Table Value
P-Value
Good Average Mild Moderate
Age in years
18-21 Years
22-25 Years
26-29 Years
Above 30 Years
3
8
5
1
4
6
4
0
1.439
df= 3
NS
P>0.05
Sig 0.697
7.81
5
6
4
1
2
7
5
0
4.813
df= 6
NS
P>0.05
Sig 0.568
12.59
Religion
Hindu
Muslim
Christian
Others
8
5
4
0
7
2
4
0
0.834
df= 2
NS
P>0.05
Sig 0.659
5.99
5
6
5
0
10
1
3
0
9.752
df= 4
S
P<0.05
Sig 0.045
9.48
Education
Illiterate
Primary/-
Secondary
Graduate
Post Graduate
4
8
4
1
0
9
4
0
4.60
df= 3
NS
P>0.05
Sig 0.203
7.81
2
9
4
1
2
8
4
0
1.608
df= 6
NS
P>0.05
Sig 0.952
12.59
Occupation
House wife
Labour
5
8
5
6
0.427
df= 2
P>0.05
Sig 0.808
5
7
5
7
4.432
df= 4
P>0.05
Sig 0.351

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Office work 4 2 NS 5.99 4 2 NS 9.48
Monthly
Income
Below 5000 Rs
5001 – 10000
Rs
10001 – 15000
Rs
Above 15000
Rs
3
5
5
4
0
6
5
2
3.283
df= 3
NS
P>0.05
Sig 0.350
7.81
1
6
4
5
2
5
6
1
4.904
df= 6
NS
P>0.05
Sig 0.556
12.59
Type of Family
Joint
Nuclear
Extended
7
3
7
7
4
2
2.431
df= 2
NS
P>0.05
Sig 0.297
5.99
7
5
4
7
2
5
5.272
df= 4
NS
P>0.05
Sig 0.261
9.48
Area of
Residency
Rural
Urban
10
7
10
3
1.086
df= 1
NS
P>0.05
Sig 0.440
3.84
11
5
9
5
2.259
df= 2
NS
P>0.05
Sig 0.323
5.99
Delivery done
at
Private Hospital
Govt. Hospital
Trust Hospital
Other
6
5
6
0
0
10
3
0
8.28
df= 2
S
P<0.05
Sig 0.016
5.99
3
7
6
0
3
8
3
0
3.801
df= 4
NS
P>0.05
Sig 0.434
9.48
Bad Habit
Smoking
Drinking
Alcohol
Others
None of the
Above
0
0
3
10
0
0
6
11
0.524
df= 1
NS
P>0.05
Sig 0.691
3.84
0
0
5
11
0
0
4
10
1.510
df= 2
NS
P>0.05
Sig 0.470
5.99
Food Pattern
Vegetarian
Non- Veg
Eggetarian
2
9
6
3
6
4
0.679
df= 2
NS
P>0.05
Sig 0.712
5.99
1
11
4
4
4
6
8.62
df= 4
NS
P>0.05
Sig 0.071
9.48
Type of Parity
Primigravida
Multigravida
7
10
7
6
0.475
df= 1
NS
P>0.05
Sig 0.491
3.84
7
9
7
7
3.95
df= 2
NS
P>0.05
Sig 0.139
5.99
Type of
Episiotomy
Medio Lateral
Median
Lateral
J Shaped
17
0
0
0
13
0
0
0
Can’t Be Computed
16
0
0
0
14
0
0
0
Can’t Be Computed

9. Journal of Pharmaceutical Negative Results ¦ Volume 13 ¦ Special Issue 1 ¦ 2022
517
Gestational
Age
40 Week
39 Weeks
38 Weeks
37 Weeks
3
8
4
2
0
3
7
3
5.86
df= 3
NS
P>0.05
Sig 0.119
7.81
2
4
5
5
1
7
6
0
7.211
df= 6
NS
P>0.05
Sig 0.302
12.59
Reason of
Episiotomy
Rigid Perineum
Big baby
Prevent Birth
injuries
Prolonged
labour
4
5
6
2
1
3
3
6
4.853
df= 3
NS
P>0.05
Sig 0.183
7.81
4
4
5
3
1
4
4
5
2.474
df= 6
NS
P>0.05
Sig 0.871
12.59
Previous place
of Delivery
Home Delivery
Institutional
Primigravida
0
2
15
0
1
12
2.851
df= 2
NS
P>0.05
Sig 0.240
5.99
0
2
14
0
1
10
0.455
df= 2
NS
P>0.05
Sig 0.797
5.99
Type of
Delivery
Normal Vaginal
Forcep assisted
Vacum Delivery
15
0
2
10
2
1
2.851
df= 2
NS
P>0.05
Sig 0.240
5.99
14
0
2
8
2
1
5.297
df= 4
NS
P>0.05
Sig 0.258
9.48
Duration of
perineal care
Every 4 hours
Every 8 Hours
Every 12 Hours
0
1
12
0
0
17
1.353
df= 1
NS
P>0.05
Sig 0.433
3.84
0
0
16
0
1
13
1.787
df= 2
NS
P>0.05
Sig 0.409
5.99
Note: S-Significant at 5% level ( p<0.05), NS-Not significant at 5% level ( p>0.05). (f)= Frequency, (%) =Percentage.
The table no.5 envisages the outcome of chi square analysis being carried out to bring out the association between the mean
differences levels of wound healing and painregarding perineal care on episiotomy among postpartum womens with their
selected demographic variables.
The calculated chi-square values higher than the table value at 0.05 level of significant.Which implies that there was association
between the Demographic variable and Reeda score on episiotomy wound healing and pain level score in experimental group
Out of all demographic variable religion status with level of pain and place of delivery with level of wound healing were found
significant associate P value <0.05 level.
Hence null hypothesis was rejected and research hypothesis was accepted as above mentioned selected demographic variables
its evidence that there is significant difference between level of wound healing and level of pain postnatal mother demographic
variables.

10. Journal of Pharmaceutical Negative Results ¦ Volume 13 ¦ Special Issue 6 ¦ 2022 518
CONCLUSION:
This study was concluded that the Perineal care On Episiotomy pain and wound healing was effective for postpartum women
there was vast difference in the Experimental and Control group’s Episiotomy wound healing and pain score of postpartum
women. The study consisted of 60 samples that were selected on the basis of non-probability convenient sampling technique.
The data analysis was done by calculating the mean, percentage, standard deviation, paired t-test and Karl’s Pearson correlation
coefficient method. The midwifery and community health nursing curriculum needs to be strengthened to enable nursing
students to know about Perineal care and its importance.
Conflict of Interest: The author had declared that there was no conflict of interest.
Sources of Funding: Self.
Ethical Clearance: The study was approved by the Institutional Ethical Committee of Dinsha Patel College of Nursing, Nadiad.
There were total 15 members in the committee from various fields. The Ethical approval reference number is
DPCN/2ndIEC/2020-21/¬¬11 and a formal written permission was gathered from the authority of PHC of Kheda-Anand
District.
Statement of Informed Consent: The informed consent form was taken from the postpartum women prior to the data collection
of the study.
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